A Guide To The Good Health Clinic Consultation Process

I thought it would be helpful to give you an overview of how I approach and manage cases. This might be useful to anyone thinking of consulting the Good Health Clinic or to those who have consulted the clinic in the past, got confused or fallen back into the ditch.  The process of leading someone away from chronic illness to regaining their level of optimum health can be viewed as a series of interventions and observations that are both therapeutic and diagnostic.

When patients initially ask me if I can help them, I reply that while I have expertise in doing the biological detective work to look for underlying causes, I have no idea whether I can help their condition until we try. This involves putting together the pieces of the jigsaw puzzle, observing how someone responds to interventions and finding out what works and what doesn’t.  This is an ongoing collaboration between patient and practitioner. In adopting this approach in my clinic, I am grateful to the work of Dr Sam Yanuck of Cogence Immunology and the application of his practical frameworks for approaching chronic, complex cases.

Initial Consultation (Information gathering)

“Listen to your patient; he is telling you the diagnosis.” Sir William Osler, Canadian surgeon (1849-1919)

The initial consultation of 90 minutes is all about gathering information. It’s about connecting the dots from the shopping list of symptoms and constructing a roadmap of the case that tells up where we are going.  The various components of the initial consultation are:

·      New Patient Forms prior to the consultation - this information enables me to start mapping the case. I am looking for things that may have been missed before.

·      Listening to the patient’s story - I find there are valuable clues to be gained in the first 10 minutes of listening to the patient’s account of what he or she feels is wrong.

·      Thorough case history plus timeline of events - this enables me to see what has happened to the patient and what may have triggered what. Patients often have cognitions about their case during this process.

·      Gathering clues - All the time I am looking out for evidence of the key drivers of chronic disease: inflammation, infections, autoimmunity, immune imbalances, digestive, neurological, thyroid, adrenal, metabolic, dental and stress-related problems.

·      Past lab results - These provide important information, even if only to rule out certain conditions. In Functional Medicine we are looking beyond the basic reference ranges.

·      Working out what lab tests need to be done now - The choice of private lab tests is greater and mire specialised than those available on the NHS. For example, patients often fall through the cracks on the NHS as tests do not always show if an infection is currently active.

·      Working out which home tests should be done. These are usually related to thyroid, adrenals and stomach acid.

·      Doing a physical observation and examination - I check the dental and tonsil areas, jaw structure, blood pressure, and anything else that is obvious from observation of the patient. Even a patient arriving late to a consultation because they couldn’t find the way tells me about their potential cognitive ability!

·      A few days after the consultation, I produce a comprehensive report for the patient outlining my first impressions of the case based on the information we have so far. This includes initial recommendations about diet, environmental factors and recommendations for lab tests to tell us more about the patient’s biological landscape.

·      When the patient has read their report and agreed on the lab tests, these are ordered and the samples are sent to the labs. The results are received approximately 2-3 weeks later ready for the next consultation.

Second Consultation (Integration)

The second consultation, which is normally 60 minutes long, takes place after I receive the patient’s lab results.  This is all about integrating information, filling in more of the roadmap and launching a structured programme. This is the first of a series of interventions to see how the patient will respond.  The components of the second consultation are:

·      Explaining the lab results to the patient - it’s important that patients understand what their results mean so they can get fully on board with the programme. It’s also important to take the guesswork and mystery out of the case, even though it may still be complex.

·      Explaining the purpose of the supplements prescribed which will be targeted against particular biological goals.  This takes away the randomness of the ‘shopping basket’ list of supplements that some people have tried.

·      Explaining that the order of introducing supplements is very important from the point of view of not making symptoms worse e.g. supporting certain parts of the immune system before introducing anti-inflammatory support.

·      Explaining the importance of changing body chemistry by avoiding inflammatory or allergic foods. I explain which foods should be avoided 100% and why ‘just one bite’ of these can ensure no progress.

·      Typically, the first steps can involve:
a)Weeks One and Two: Basic immune support in place.

b)Weeks Three and Four: Add anti-inflammatory/autoimmune support to the plan.

The patient receives a short report outlining their recent test results and the starting steps of the plan.

I schedule the next consultation for a month later.

Third Consultation (Evaluation and Personalisation)

The length of the third consultation can be flexible, depending on how long we need.  This is all about evaluating the first intervention, and how to go forward and address the unique factors on the case. The key components of the third consultation are:

·      Evaluating the intervention:

a)Have there been any improvements?

b)Is the patient not improving? Why not?

c)Are they on target?

d)Did they follow instructions?

e)Are there barriers to compliance?

f)Are they distracted by other ideas?

g)Are they hypersensitive/can’t get past step one?

·      If someone is improving, we keep doing the successful actions, while moving them forward on the programme.  Week Five is the point to start attending to the unique factors of a person’s case. These could include:

a)Addressing infections directly.

b)Addressing low white blood cell counts.

c)Addressing mast cell activation.

d)Addressing gut issues.

e)Addressing dental infections.

f)Addressing tonsil issues.

g)Addressing anything else that is important on the case.

·      If they are not improving, we look at why this may be - are they following the programme accurately? Are they neglecting vital parts?  If it is the latter, focus on accuracy, not changing the plan. 

·      If they are doing things accurately but not improving, look for any important factors that may have been missed.

·      If they have been distracted by other things and think they should be trying something else, I go over their test results once again and point out that if they do something else, they may never get past square one.

·      If they experience heightened reactions to supplements, I look at improving the general terrain or connective tissues, focusing on subtractions for a while and supporting vagal function. Then, when improvements have been made, starting on very low doses of supplements one at a time.

I schedule the next consultation for a month later.

Fourth Consultation (Consistency)

The fourth consultation is about the need for consistency of actions.  Sometimes, if patients think they are not making sufficient progress fast enough, they wander off and do something else without giving the programme a fair chance. If someone has been ill for years, it is going to take more than a few weeks to make a significant improvement. The key components of the fourth consultation are:

·      Stay focused on the factors of the case we are sure about from the test results and see if there are things that could be improved.

·      Observe anything that is getting worse and take steps to investigate and correct this as needed.

·      Be aware that the chief obstacle to consistency is often boredom. People get bored doing the same things and want to make changes because something looks more attractive or more instant on an internet forum. Internet forums can’t see your lab results and it is usually a waste of time to go plunging down an untried rabbit hole without a good reason.

·      When someone starts to feel better, keep the plan the same for three months to consolidate the gain, then do a carefully controlled programme to see what supplements can be tapered down successfully.  See what needs to be left in place.

·      Recognise what needs to be in place for the maintenance of the gains.

Schedule the next consultation for three months from now. Subsequent consultations will then be as needed.

If you would like to book a consultation, please get in touch with the Good Health Clinic on goodhealthclinic@outlook.com to request a free 30 minute Enquiry Call or book an appointment. Please note that an Enquiry call is not a consultation but an exploratory call to see if this is a clinical approach you wish to pursue.

To your very good health,

Suzanne Jeffery (Nutritional Medicine Consultant)

M.A.(Oxon), BSc.(NMed), PGCE, MNNA, CNHC

The Good Health Clinic at The Business Centre, 2, Cattedown Road, Plymouth PL4 0EG

Tel no: 07836 552936/ Answer phone: 01752 774755 

Disclaimer:

All advice given out by Suzanne Jeffery and the Good Health Clinic is for general guidance and informational purposes only.  All advice relating to other health professionals’ advice is for general guidance and information purposes only. Readers are encouraged to confirm the information provided with other sources.  Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by other practitioners and physicians. Suzanne Jeffery and the Good Health Clinic will not be liable for any direct, indirect, consequential, special, exemplary or other damages arising therefrom.